Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK.
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Am J Sports Med. 2022 Jun;50(7):1823-1831. doi: 10.1177/03635465221092118. Epub 2022 May 5.
Although a medial collateral ligament (MCL) injury is associated with anteromedial rotatory instability (AMRI) and often with an anterior cruciate ligament (ACL) injury, there has been little work to develop anteromedial (AM) reconstruction to address this laxity.
To measure the ability of a novel "anatomic" AM reconstruction technique to restore native knee laxity for isolated AM insufficiency and combined AM plus posteromedial insufficiency.
Controlled laboratory study.
A total of 12 cadaveric knees were mounted in a kinematic testing rig that allowed the tibia to be loaded while the knee flexed-extended 0° to 100° with 88-N anteroposterior translation, 5-N·m internal rotation-external rotation (ER), 8-N·m valgus, and combined anterior translation plus ER to simulate AMRI. Joint motion was measured using optical trackers with the knee intact, after superficial MCL (sMCL) and deep MCL (dMCL) transection, and after AM reconstruction of the sMCL and dMCL with semitendinosus autografts. The posteromedial capsule (PMC)/posterior oblique ligament (POL) was then transected to induce a grade 3 medial injury, and kinematic measurements were repeated afterward and again after removing the grafts. Laxity changes were examined using repeated-measures analysis of variance and post-testing.
sMCL and dMCL deficiency increased valgus, ER, and AMRI laxities. These laxities did not differ from native values after AM reconstruction. Additional PMC/POL deficiency did not increase these laxities significantly but did increase internal rotation laxity near knee extension; this was not controlled by AM reconstruction.
AM reconstruction eliminated AMRI after transection of the dMCL and sMCL, and also eliminated AMRI after additional PMC/POL transection.
Many MCL injuries occur in combination with ACL injuries, causing AMRI. These injuries may rupture the AM capsule and dMCL. Unaddressed MCL deficiency leads to an increased ACL reconstruction failure rate. A dMCL construct oriented anterodistally across the medial joint line, along with an sMCL graft, can restore native knee ER laxity. PMC/POL lesions did not contribute to AMRI.
虽然内侧副韧带（MCL）损伤与前内侧旋转不稳定（AMRI）相关，且常与前交叉韧带（ACL）损伤相关，但目前很少有研究致力于开发前内侧（AM）重建以解决这种松弛。
测量一种新型“解剖”AM 重建技术在治疗单纯 AM 不足和 AM 加后内侧不足时恢复膝关节自然松弛度的能力。
对照实验室研究。
共 12 个尸体膝关节被安装在运动学测试装置中，允许胫骨在膝关节从 0°到 100°屈伸时加载，同时施加 88-N 的前后平移、5-N·m 的内旋-外旋（ER）、8-N·m 的外翻和前向平移加 ER 模拟 AMRI。使用带有膝关节的光学跟踪器测量关节运动，然后在浅层 MCL（sMCL）和深层 MCL（dMCL）切断后，以及使用半腱肌腱自体移植物进行 sMCL 和 dMCL 的 AM 重建后进行测量。然后切断后内侧囊（PMC）/后斜韧带（POL）以诱导 3 级内侧损伤，之后重复进行运动学测量，然后在去除移植物后再次进行测量。使用重复测量方差分析和事后检验检查松弛度变化。
sMCL 和 dMCL 缺失增加了外翻、ER 和 AMRI 的松弛度。这些松弛度在 AM 重建后与自然值无差异。额外的 PMC/POL 缺失并没有显著增加这些松弛度，但确实增加了膝关节伸直时的内旋松弛度；这不能通过 AM 重建来控制。
在切断 dMCL 和 sMCL 后，AM 重建消除了 AMRI，在额外切断 PMC/POL 后也消除了 AMRI。
许多 MCL 损伤与 ACL 损伤同时发生，导致 AMRI。这些损伤可能会撕裂 AM 囊和 dMCL。未处理的 MCL 缺失会导致 ACL 重建失败率增加。一个从后向前横跨内侧关节线的 dMCL 结构，加上一个 sMCL 移植物，可以恢复膝关节 ER 的自然松弛度。PMC/POL 病变不会导致 AMRI。
